Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 406214335
Report Date: 03/09/2018
Date Signed 03/09/2018 04:21:52 PM


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/08/2018 and conducted by Evaluator Juvenal Moctezuma
PUBLIC
COMPLAINT CONTROL NUMBER: 17-CC-20180308150623
FACILITY NAME:NIPOMO RECREATION-LITTLE BITS PRESCHOOL & TODDLERFACILITY NUMBER:
406214335
ADMINISTRATOR:NANCY MAROHNFACILITY TYPE:
850
ADDRESS:112 ORCHARD ROADTELEPHONE:
(805) 929-5437
CITY:NIPOMOSTATE: CAZIP CODE:
93444
CAPACITY:60CENSUS: 18DATE:
03/09/2018
UNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Kathy BumgardnerTIME COMPLETED:
04:35 PM
ALLEGATION(S):
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1. Facility has a broken window which posses a safety hazard to daycare children.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Maria Mueller and Juvenal Moctezuma conducted an annual random visit and met with Director Kathy Burngardner. Director was informed the reason for the visit. LPAs toured the center inside and outside. The broken glass was observed in the main classroom. Director stated that the window broke last week and the window is scheduled to be fixed next week.
The glass is cracked, and when LPA touched the glass, the glass is separated, held by the window frame. The window is accessible to children and this poses immediate threat to children.
Based on observation and interview which were conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, and Division 12) are being cited on the attached LIC 9099D.
Appeal rights given and explained. This report must be posted for 30 days. Director will provide a copy of this report to each parent/legal guardian of every child for the next 12 months and newly enrolled parents also. Every parent/guardian must sign a LIC 9224 , "Acknowledgment of Licensing Reports" and place a copy of this document in each child's file for the next 12 months.
LPAs observed Director post the Notice of Site visit.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Deborah AjaoTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Juvenal MoctezumaTELEPHONE: (805) 689-6267
LICENSING EVALUATOR SIGNATURE:

DATE: 03/09/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2018
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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Control Number 17-CC-20180308150623
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: NIPOMO RECREATION-LITTLE BITS PRESCHOOL & TODDLER
FACILITY NUMBER: 406214335
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/09/2018
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/12/2018
Section Cited
CCR
101238(a)
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Buildings and Grounds. The child care center shall be clean, safe, sanitary and in good repair at all times.

LPAs observed a window with broken glass in the main classroom. Per Director, the window broke last week.
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Director will sbumit proof of correction that the window has been replaced or fixed, by March 12, 2018.

Director temporarily covered the broken glass with a cardboard and taped the glass.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Deborah AjaoTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Juvenal MoctezumaTELEPHONE: (805) 689-6267
LICENSING EVALUATOR SIGNATURE:

DATE: 03/09/2018
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2018
LIC9099 (FAS) - (06/04)
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